RAISING A HANDICAPPED CHILD: STRESS AND COPING STRATEGIES AMONG

PARENTS OF CHILDREN WITH DISABILITY IN SANTIAGO CITY, ISABELA

A Thesis

Presented to

The Faculty of the Social Sciences Department

College of Arts and Sciences

ISABELA STATE UNIVERSITY

Echague, Isabela

In Partial Fulfillment

of the Requirements for the Degree

BACHELOR OF SCIENCE IN PSYCHOLOGY

By

ALAINE DANICA I. DIMAANDAL

May 2020
 APPROVAL SHEET

The thesis attached hereto titled, “RAISING A HANDICAPPED CHILD: STRESS

AND COPING STRATEGIES AMONG PARENTS OF CHILDREN WITH DISABILITY
IN SANTIAGO CITY, ISABELA”, prepared and submitted by ALAINE DANICA I.
DIMAANDAL in partial fulfillment of the requirements for the degree, BACHELOR OF
SCIENCE IN PSYCHOLOGY, is hereby endorsed.

ADVISORY COMMITTEE

MA. VICTORIA T. JUAN, Ph.D.

Thesis Adviser

Date: ________________

RODERICK B. VALDEZ HELENA B. FLORENDO, Ph.D.

Member Member

Date: ________________ Date: ________________

Accepted in partial fulfillment of the requirements for the degree Bachelor of Science in
Psychology.

MA. VICTORIA T. JUAN Ph.D. __________________

Chairman, Social Sciences Department DATE

FRANCIS T. MATAY-EO JR., MA __________________

College Research Coordinator DATE

HELENA B. FLORENDO, Ph.D. __________________

Dean, College of Arts and Sciences DATE

Recorded:

AMBROCIA A. GAFFUD, Ph.D. ___________________

Registrar DATE
 ACKNOWLEDGEMENT

Despite the challenges, obstacles and tiresome days the researcher had gone through, she

had somehow triumphed and reaped the fruit of such endeavor, but admittedly, she is indebted to

many people who helped her in many ways. Hence, the researcher would like to extend her

profound gratitude and regards to the following persons who gave a helping hand to achieved her

goal:

To Dr. Ma. Victoria T. Juan, her thesis adviser for genuinely giving her full-time effort

and served as a mother figure and for her constant reminders and openness to help. Also, for

always helping her in every step of the way, for imparting knowledge, for continuously making

her motivated, for sharing words of encouragement to push herself to her limits, and most

importantly, for allowing and accommodating her as one of her thesis advisee.

To Mr. Roderick B. Valdez, one of the panel member, for giving suggestions and

recommendations to make her study better, also for giving pieces of advice and enlightenment

when she lose faith and hope.

To Dr. Helena B. Florendo, dean of the college and her panel chairman, for giving

important pieces of advice, lessons in life and words of wisdom that boosted her confidence.

To Mrs. Rechelle M. Danoz, her statistician, for lending her full time for explaining

everything with regards to the data gathering and table making.

To all her teachers and professors in the past, for inspiring and motivating her to gave

his best.
 To all his classmates and friends, for their moral support, and the laughter they brought

duting tiring times.

To her loving and supportive family, especially to her father, Allan N. Dimaandal and to

her mother Emily I. Dimaandal, who always gives her moral support; to her sister, Rowena

Grace I. Asis, to her brother, Christopher I. Asis, who always gives her moral and financial

support, who encouraged, gave pieces of advice and pushed her to the limit.

Finally, his lasting gratitude is extended to the Almighty God, for His immeasurable

blessings to her.

The Researcher
 DEDICATION

This piece of work

is lovingly dedicated to the readers; to her love ones,

who motivated, guided, and gave their full support;

to all who believed in her ability and to those who didn’t,

and above all, to Lord God

who had showered His abundant blessings and love at all times.

Now, another dream came into reality.

-Alaine Danica
 TABLE OF CONTENTS

TITLE PAGE ……………………………………………………………………………...i

APPROVAL SHEET …………………………………………………………………..…ii

ACKNOWLEDGEMENT …………………………………………………………….…iii

DEDICATION ………………………………………………………………………...…iv

TABLE OF CONTENTS …………………………………………………………………v

LIST OF TABLES ……………………………………………………………………….vi

Abstract …………………………………………………………………………………...1

Introduction ……………………………………………………………………………….2

Method ……………………………………………………………………………………3

Results ……………………………………………………………………………………

Discussion ………………………………………………………………………………..

References ………………………………………………………………………………..

APPENDICES ……………………………………………………………………………..
 LIST OF TABLES

Table 1

Table 2a

Table 2b

Table 3a

Table 3b
Running Head: RAISING A HANDICAPPED CHILD: STRESS AND COPING STRATEGIES
AMONG PARENTS OF CHILDREN WITH DISABILITY

RAISING A HANDICAPPED CHILD: STRESS AND COPING STRATEGIES AMONG

PARENTS OF CHILDREN WITH DISABILITY IN SANTIAGO CITY, ISABELA

Alaine Danica I. Dimaandal

Isabela State University

Abstract
 RAISING A HANDICAPPED CHILD: STRESS AND COPING STRATEGIES

AMONG PARENTS OF CHILDREN WITH DISABILITY

Based on the 2010 census of Philippine Statistics Authority (2010 PSA), 16 per thousand

of the country’s population had disability and for every 5 PWD, 1 (18.9 percent) was aged 0 to

14 years. A disability is a physical or mental impairment that substantially limits one or more

major life activities, such as caring for oneself, performing manual tasks, seeing, hearing, eating,

sleeping, walking, standing, lifting, bending, speaking, learning, reading, concentrating, thinking,

communicating, and working. A disability can be related to conditions present at birth and may

affect functions later in life. Such conditions include disorders in single genes, chromosomal

disorders, or a mother’s exposure to infections during pregnancy. Additionally, a disability can

be associated with developmental conditions that become apparent during childhood or are

related to an injury, associated with a long-standing condition, or a progressive illness. The

individual must have a record of impairment and be regarded by others as having such

impairment. The World Health Organization proposes the following definition of disabilities:

Disabilities is an umbrella term, covering impairments, activity limitations, and participation

restrictions. Impairment is a problem in body function or structure; an activity limitation is a

difficulty encountered by an individual in executing a task or action; while a participation

restriction is a problem experienced by an individual in involvement in life situations. Disability

is thus not just a health problem. It is a complex phenomenon, reflecting the interaction between

features of a person’s body and features of the society in which he or she lives. (World Health

Organization). Overall, children born with birth defects or who are developmentally disabled

often need special care and interventions to survive and thrive developmentally.
 Raising a child with a disability can be an overwhelming and emotional experience and

can pose many difficulties for parents. Benson (2012) explained the long term care of a child

with a chronic disability frequently affects various areas in a parent’s life domains (e.g.,

marriage, career, relationships), which can lead to stress, and often affects the overall functioning

of the family. In addition, parents work to balance their marriages with demands that accompany

having a child with special health care needs. Because children with disabilities may require

continuous medical support to meet their needs, a parent’s career is then affected because of a

high rate of absences and reduced work hours. Equally important, relationships with family and

friends can become fragmented by the continuous demands of having a child with a disability,

leaving little or no time for fostering such relationships. Moreover, research has shown that

parents of children with disabilities experience higher levels of stress and are at higher risk for

mental health issues than those with typically developing children (Trute, HiebertMurphy, &

Levine, 2007). The theoretical perspective guiding this study was the work of Richard S.

Lazarus, PhD, and his belief about an individual’s stress and coping styles. According to

Lazarus, stress is a two-way process; it involves the production of stressors by the environment

and the response of an individual subjected to these stressors (Lazarus, 1993). His conception of

stress led to the theory of cognitive appraisal. Lazarus stated that cognitive appraisal occurs

when a person considers whether a particular situation within the environment is relevant to his

or her well-being and, if so, in what ways. In the stage of primary appraisal, an individual

assesses whether or not he or she has anything to lose. That individual may ask, “What does this

stress or situation mean?” and “Is the health or well-being of a loved one at risk?” In secondary

appraisal, the individual evaluates if anything can be done to overcome or prevent harm or to

improve the potential for benefit (Folkman, Lazarus, Dunkel-Schetter, DeLongis, & Gruen,
1986). Secondary appraisals involve those feelings related to dealing with the stressor or the

stress it produces. Positive secondary appraisal statements may include, “If this way fails, I can

always try another method” and “I can do it if I do my best.” In contrast, statements such as “I

can’t do it; I know I will fail” indicate negative secondary appraisal statements. In secondary

appraisal, various coping options are evaluated by the individual, including altering a situation,

accepting the situation, seeking additional information, or holding back from acting impulsively

and in a counterproductive manner. Lazarus proposed primary and secondary appraisal converge

simultaneously in an effort for the individual to determine whether the person-environment

stressor is regarded as significant for one’s well-being and, if so, what classification it falls

under: threat or challenge. In a threat, the person regards the situation as containing the

possibility of harm or loss. In contrast, when viewed as a challenge, the person views the

situation as holding the possibility of mastery or benefit, leading to the development of a positive

stress response (Folkman et al., 1986). Overall, stress appraisals result from perceived situational

demands in relation to perceived coping resources; thus, the ability to successfully navigate those

stressors is dependent on the person’s coping strategies. Lazarus emphasized people alter their

circumstances to make it appear more favorable in an effort to cope. Coping is an individual’s

continuous effort in thoughts and actions to manage specific external or internal demands

appraised to be challenging and overwhelming to the individual. In addition, coping is

considered highly contextual, in that its effectiveness is determined by the ability to change over

time and across different conditions (Folkman & Lazarus, 1985). To expand, coping has two

widely recognized major functions: regulating stressful emotions, called emotional-focused

coping, and changing the troubled person-environment relation that is causing the distress, which

is referred to as problem-focused coping. Emotional-focused coping is change only in the way in

which the individual interprets what is happening, such as using the technique of distancing to

remove the cognitive basis of the stress reaction. Problem-focused coping is when an

individual’s relationship with the environment is changed by the coping action (Folkman &

Lazarus, 1985). When examining stress and coping, and whether the change is because of an

external condition or from the analysis of it, coping affects psychological stress through

appraisal; therefore, appraisal is always considered to be the mediator (Lazarus, 1993). In

conclusion, cognitive appraisal and coping are critical mediators of the stressful person-

environment relationships for parents as they navigate the immediate and long-term outcomes.

Previous research has shown that with the appropriate support and guidance, parents of children

with a disability can cope effectively with the many challenges presented and, in turn, become

advocates for their child (Shilling et al., 2013). Therefore, from the individual and societal

perspective, identifying and understanding what factors cause parental stress as well as

identifying coping strategies that have been beneficial for parents are important for the treatment

of the child, the parent or caregiver, the family as a whole, and the community.

Limited research exists regarding the parents’ and caregivers’ perspectives and their

voice in guiding theory and practice regarding family stress and resiliency in families raising

children with disabilities. First, because much of the research has pertained to the distinct

challenges and lives of families of children with disabilities, taking a strength-based approach to

add to the current literature on family coping can have significant implications for theory and

practice. Second, this paucity of research means that current theory and practice may lack critical

data that can help parents adapt and cope during stressful periods in their lives. Therefore, the

major goal of this study was to achieve a more thorough understanding of these families as a

fundamental building block for future research and practice.

 Although limited research exists pertaining to the stress and coping process of raising a

child with a disability, this research has yielded varied results regarding the effects of families

caring for a child with a disability. Therefore, this is a significant concern for this understudied

but large population. Specifically, some researchers have noted significant stress within families,

while others have indicated families have tremendous resilience in helping each other cope with

their challenges (Bayat, 2007; Benson, 2006; Benson & Karloff, 2009; Debrowska & Pisula,

2010; Feldman et al., 2007; Myers, Mackintosh, & Goin-Kochel, 2009; Retzlaff, 2007; Van

Riper, 2007). Furthermore, the degree of stress and adjustment is dependent on appraisal of the

stressors, coping ability, and emotional resources (Folkman et al., 1986). Parents of children with

a disabling condition face various challenges that are often not addressed, as resources tend to be

primarily child focused (Woodgate, Ateah, & Secco, 2008). The first challenge faced by parents

of children with a disability is social isolation. Family members and friends do not always

understand the needs of a child with a disability and may not be able to provide child care

support. In addition, activities, such as community outings and recreational activities are

frequently reduced because of caregiver demands. A second challenge reported in the literature is

that raising a child with a disability causes significant financial stress. Current research has

shown the percentage of families with both parents in the workforce is higher than those with

only one parent working (Parish, Seltzer, Greenberg, & Floyd, 2004). Raising a child with a

disability may force working parents to reduce their hours or stop working entirely to care for

their child, thus reducing family income. This, coupled with the need for specialized services and

the out-of-pocket medical expenses, represents a significant financial burden for many parents

raising a child with a disability (Reichman, Corman, & Noonan, 2008). A third concern is the

well-being of the parents. The increased stress that accompanies raising a child with a disability
can negatively affect the emotional, mental, and physical health of the parents trying to balance

the needs of their healthy and unhealthy children, work demands, financial demands, and the

overall functioning of the family. In addition, the parents may feel guilt and blame, become

depressed, or experience reduced self-esteem. At the same time, living with a child with a

disability has also been shown to have significant positive effects on the family and is a unique,

potentially enlightening shared experience for families (Williams, Piamjariyakul, Graff, &

Stanton, 2010). This situation has broadened horizons, increased family members’ cognizance of

their own inner strengths, enhanced the family unity, and encouraged connections to religious

affiliations and community groups. In conclusion, all of these potential factors may significantly

affect the quality of the relationships between the parents, additional family members, and the

family structure (Reichman et al., 2008).

The purpose of this study was to investigate the relationship between a parent’s coping

mechanisms (confrontive coping, distancing, self-controlling, seeking social support, accepting

responsibility, escape-avoidance, planful problem solving, and positive reappraisal) on his or her

mental health or distress (depression, hopelessness, anxiety, and anger) when raising a child with

a disability. Through this study, the researcher sought to identify particular coping mechanisms

that may affect mental health in a positive or negative way, thereby helping counselors

encourage positive coping strategies to alleviate parents’ psychological distress in raising a child

with a birth or developmental disability. In addition, the researcher investigated whether positive

and adaptive coping behaviors alone can result in better mental health outcomes or if additional

supports are needed. Efforts to understand the coping process of this understudied population can

assist researchers in designing interventions that address the key components of the adjustment

process, including identification of maladaptive stressor appraisals and coping strategies.

Folkman and Lazarus proposed one of the most comprehensive theories of stress and coping in

literature; however, their model has received insufficient empirical attention regarding parents’

stress and coping when raising child with a disability. In addition, some existing research has

yielded conflicting results. The increasing demand for psychologists with knowledge in this

specialty area justifies the need for more effective, life-changing approaches. Thus, psychologists

will be essential to the stress management of parents of children with disabilities.

Raising a child with a disability can have profound effects for the parents and for the

entire family unit. It is a unique shared experience for families and can affect all aspects of

family functioning. The long-term care of a child with a disability frequently affects various

areas in parents’ life domains (e.g., marriage, career, relationships), which can lead to stress and

affect the functioning of the family as a whole. Research has shown that parents of children with

disabilities experience higher levels of stress and are at a higher risk for mental health issues and

affected well-being than those with typically developing children (Benson, 2012; Trute et al.,

2007).

Based on the 2010 census of Philippine Statistics Authority (2010 PSA), 16 per thousand

of the country’s population had disability and for every 5 PWD, 1 (18.9 percent) was aged 0 to

14 years. Developmental disabilities are a group of conditions caused by impairment in physical,

learning, language, or behavior areas. These conditions begin during the developmental period,

may affect day-to-day functioning, and usually last throughout a person’s lifetime.

Parents face a multitude of changes when raising a child with a disability. The parental

roles are often redefined and can become a significant challenge and burden for parents. Parents

of children with disabilities encounter new and unfamiliar challenges that redefine the familiar
role of parents to advocates, medical caregivers, and organizers of structured activities. Parents

also face stressors that can include financial issues, marital discord, and social isolation.
 Method

This section contains the research design that was used in the research, the participants

involved in the study, instruments for measuring conflict management styles and psychological

well-being, the procedures how the study was conducted and the statistical treatments in

gathering data.

Participants

The participants of this study were

Research Design

This study followed a quantitative design, as the researcher sought to determine if a

relationship existed between two variables by using two questionnaires. To assess the

relationships, a series of Pearson’s correlations were conducted. The first correlation was

conducted to determine if the parents’ problem-focused coping influenced their level of

psychological distress. A second Pearson’s correlation allowed the researcher to compare the

subscales of emotional-focused coping with a parent’s psychological distress.

Measures and Materials

To answer the objectives of the study, the researcher utilized a mixed methods design that

consisted of two questionnaires and 10 written responses to questions designed by the researcher.

The first questionnaire was the Ways of Coping Questionnaire (WCQ). It consists of 66

questions that comprise eight subscales: Confrontive Coping, Distancing, SelfControlling,

11
Seeking Social Support, Accepting Responsibility, Escape-Avoidance, Planful Problem Solving,

and Positive Reappraisal. The second questionnaire was entitled the Psychological Distress

Profile (PDP). It consists of 20 questions and four subscales: Depression, Hopelessness, Anxiety,
and Anger. The 10 written questions were,

1. How did you first find out your child had a birth defect or developmental disability?

2. Do you think it was better to cope with a disability or your own mental health or both?

3. What advice would you give to parents who just found out their child has a disability?

4. What greatest joy has this circumstance brought you?

5. What resources, if any, did you seek out?

6. What resources, if any, were most helpful?

7. How has raising a child with special needs changed your life?

8. With whom, if anyone, did you share your feelings?

9. What do you think was the missing link in helping you navigate this situation?

10. Who provided you with the most support as you navigated through the world of

raising a child with a disability?

Ways of Coping Questionnaire. The WCQ (Folkman & Lazarus, 1985) assesses

thoughts and actions individuals use to cope with the stressful encounters of everyday living. It is

derived from a cognitive-phenomenological theory of stress and coping that is articulated in

Stress, Appraisal, and Coping (Folkman & Lazarus, 1985) and elsewhere (e.g., Lazarus, 1981;

Lazarus & Launier, 1978). The measure consists of 66 items that comprise eight subscales:

Confrontive Coping (6 items), Distancing (6 items), SelfControlling (7 items), Seeking Social

Support (6 items), Accepting Responsibility (4 items), Escape-Avoidance (8 items), Planful

Problem Solving (6 items), and Positive Reappraisal (7 items; see Appendix A). The 16 items

were not scaled or scored. The respondents were asked to rate the extent to which they used the

coping behavior during a stressful situation on a 4-point Likert scale that ranged from 0 (Does

not apply or not used) to 3 (Used a great deal). Raw subscale scores ranged from 0 to 24. High

raw scores indicated that person frequently used the behaviors described by that scale in coping

with the stressful event. Relative scores described the proportion of effort represented for each

type of coping and were expressed as a percentage that ranged from 0 to 100. A high relative

score on a scale meant the person used those coping behaviors more than they used other

behaviors. Folkman and Lazarus (1985) considered the traditional test-retest estimates of

reliability to be inappropriate, as the WCQ measures coping as a process, which by definition is

variable. However, reliability in terms of internal consistency of the coping measure can be

evaluated. Lundqvist and Ahlström (2006), using the root mean squared error of approximation

(RMSEA), found that the internal consistency yielded an acceptable fit. These findings were

consistent with Edwards and O’Neill (1998) and Parker, Endler, and Bagby (1993) and provided

support to the 8-factor model of the WCQ. Items at the beginning of the WCQ ask the

participants to provide the date, identification number (optional), gender, and marital status.

Psychological Distress Profile. The PDP (Elkins & Johnson, 2015) is a brief measure of

four common domains of psychological distress. The PDP consists of 20 items that comprise

four subscales: Depression (5 items), Hopelessness (5 items), Anxiety (5 items), and Anger (5

items; see Appendix B). The respondents were asked to rate their belief about their problems on

a 5-point Likert scale, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). Subscale scores

ranged from 5 to 25. A higher subscale score was indicative of a higher level of distress on a

particular construct of psychological distress. Elkins and Johnson (2015) found relatively high
levels of internal consistency across samples and sexes ranging, from 0.87 to 0.95. Researcher-

designed questions. The researcher designed the written questions, which guided empirical

research findings on raising a child with a disability (see Appendix C). The 10 questions were

designed to provide parents with the opportunity to express their personal experiences in raising

a child with a disability. Answers to the questions provided a richness to the research study in

allowing parents’ to describe raising a child with a disability.

Procedure

In order to achieve the objectives of the study, the researcher followed the chronological

phases of data gathering. First, the researcher prepared all the necessary documents and letters

needed for the conduct of the study, namely; Communication, Informed Consent, Questionnaires

and Permission to start. Participants recruited from within the local elementary, middle, and

high schools, as well as by asking colleagues, personal contacts, and referrals with a child who

has a diagnosed developmental disability or is classified as requiring special education and

related services. Participants were told that the purpose of the study was to investigate their

coping behaviors and psychological distress in raising a child with a disability. Each participant

was randomly assigned a number. Participants were asked to complete the 66- item questionnaire

from the WCQ and the 20-item questionnaire from the PDP, as well as the 10 researcher-

developed questions regarding their personal experiences raising a child with a disability.

Statistical Tool